"Background: Heart Failure remains one of the leading causes of death in the United States. Individuals in rural communities experience higher rates of heart failure diagnosis and mortality compared to urban populations. Barriers and differences influenced by socioeconomic status, access to healthcare, race, and sex contribute to these differences.
Objective: This systematic review examined the current knowledge regarding rural-urban disparities in heart failure incidence and mortality, and identified how sex, race, age, and socioeconomic status contribute to these differences. Methods: Following the PRISMA guidelines, a systematic literature review was conducted using CINAHL, MEDLINE, and Healthsource: Nursing Academic Edition databases. The search terms included heart failure OR cardiovascular disease, rural OR non-metropolitan, and poverty OR socioeconomic. Peer-reviewed studies published within the past 10 years were included if they reported heart failure incidence or mortality classified by rural vs urban and demographic subgroups. Four studies met the inclusion criteria and were analyzed using a literature review matrix to identify common outcomes and patterns. Results: Throughout the studies, rural populations consistently showed higher rates of heart failure incidence and mortality compared to urban populations. Black men, women, and low-income groups were especially affected. The findings pointed to reduced access to healthcare services, lower procedural intervention rates, race, gender, lifestyle, and socioeconomic differences as key factors contributing to these disparities. Two studies also reported that the gap in Heart failure-related mortality has widened in rural areas in recent years. Conclusion: Rural-urban disparities in heart failure outcomes show the existing inequities in access to healthcare and socioeconomic factors. Nursing practice and public health efforts should focus on improving early diagnosis, cardiovascular education, and making resources available in rural areas. There are limited articles on this topic. Targeted policy initiatives are important in order to lower preventable deaths and promote health equity in heart failure care."
